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CIT Y OF EDMONDS Permit No. P3—ic'
PUBLIC WORKS DEPARTMENT STREET FILE Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. eAddress or vicinity of Construction
21907 95th Av. W. Plat #164-067,UI2
9 Owner: Washin&ton Natural Gas Co.
Name
8U5 156th Av. N.E.
Mailing Address
Bellevue, Wa. 98007
city, State, Zip Code
0 Contractor: same as above
Name
Mailing Address
City, State, Zip Code
e Permit Issued To:
Type of Work to be Done: install new mas
service
0 Work in Connection With:
11 Sub or Plat El Single Family
11 Comml. / Ind. El Apt. Condo.
0 Pavement Cut: El Yes 0 No
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal
proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering.
Call 775-2525, extension-MM.
I understand that this pemr lvvik�_ the jffl site for inspection purposes at all times.
Signature: Owner or Agilt Date —
6-13-83
THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. lssucd By:
Time Authorized: Void after 30 —days
Special Conditions:
Ammendments:
Permit Fee: 30 �0—
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
x
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
Ena. Div. December 1978
I
NOTICE,
rac.-
'O"W'a-r-ranty ... 0 r_aC_TU
N formation'shown on the a-ttached
The in
map(s) was coM ' piled for use by the UtY 01
Edmonds/ its Empl-oyees and Consultants.
Th,e City of EcIm.onds does. not, warrant the
n these
accuracy of anything set for.th o
map(s). An - y person or entity -requesting a
copy should conduct an independent
inquiry regarding the Infoirm-ation shown-c
ff�e -m a P (S) / including, but not i'mited to,
n of any sewer stub shown. Su(
the lociatio
y or may' not exist and rna�
sewer stubs ma
t the location shown,
or may not exist a
,�*ty of Edrnon'(JAS nor its
Neitheir the k--.] ice*rs -sha-H be 1--jab],.e for iffi
empil-o-yee-s 0-r Off.
information given on ffs map(5), nor for
any one representation provided based
upon said map(S'
APPLICATION
L--
%.-ity of Edmonds for EASEMENT NO . ............................... ............
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO. NO. ----------
OWNER------------- ............................................................................... CONTRACTOR -------------------------------- --------------------------------------------------- PERMIT NO.
JOB ADDRESS —ef,' - W- LEGAL DESCRIPTION: LOT NO - ----- tr?
I -------------- ------- ------------- ------------------------ -------------------- --------------------------------- BLOCK NO - ------ -- ..........................
9
----------------------------------------------------------------------------------------------------------------------------------
-? -T I P�-4 '*" �E�
DDITION ----- '�—:!> ----- Ls-C3P%� --------------------------------------------------
Approved:
/ByW� z
DATE-- - - -------------------- -- ------------
�CITY "OF MM. ONIDS, R.- N
S� 7
WATEI?�SEW,ER,.1�D,EPANRTMENT:-.1
PERMIT 533 4
all' 7,75-2525 for'side sewer inspections- BEFORE co�ering. any portion. of 'the 'construction.),_,
Inspection will be proNiideo�.withln 24 hours�'afte�r: iequst. NO Sat., Sun., or holiday lnspections�
tADDRESS4LOCA'nONf,;OF--'i",ONSTRUCT-ION ........
........................................................... ............ W
........................... ....... ................................
6ESCRIPTIE) ..... n!Qt� ......... ..........
N ........ ...........
................................................. . ..............................................
............................... .................................. z .....................
................. ........................... .....................
OMWER ANWOR BUILDER ............ ................ ...................... ...................................... .................
C�6��TRACT-Olt!S�i4,AM,t!�&-A,-DDRESS; .... ........................................ ......
. .. . .......... 1, ..........
Permilision: W jiant6d: ........
...... "7 ......... and/or' connection of a; side sewer to the city. sanitary sewer,
�Sv-i in�acc&i_ gdc�,wlt.hl Cf ty�of Edmonds ordinances.
r
A'17.1'�NTWN;. IS;.CALLED. TO, THk FOLLOWING:
NOTE No. k—The, o��hers of the, property may obtain w permit to construct sewer 'inside property line. A licensed. Side Sewer Contractor must,be employed to construct
slde�s,ewer, in street area. Do not cover any portion of.sewer before It has been Inspected,.
NOTE No. 2—AIII , -.wbrk,performed'An. city right-of-way requires an Invasion of RIght-of-Way Permit obtaJrrable from. the City �Englneer's, office.
-NO TE'No' b �f
�3�O tit ull, information iegarding Ordinance 1.1. 16.030 and Regulations 'governing. side sewers,when you, get permit.
No Q4,
o;, 4—.Top.V Alde� sewer.nidat,ladver at least 30 inches coverage at property line and, 12 Inches inside property line; minimum: gradc of 2 No, -bends In grade
-4,96a6ei�tha:n 1,� will,'be permitted.
'NOTE itreet%must -be water settled and'surface of street restored- to origjInal condition. Contractors shall be.responsible for failure 'due to improper!
i',,vdik, whi6h, may 4evelop within, one year of completion.
NOTE N _I Awialter or Ldo any other work than Is provided, for In the permit, or to doi any work on, the main sawer,,o�'its. appurtenances. except
:�Ai-seft�4fie�?Ipl P 'Into to in
a AheAvye.
DISAPPROVED,_� [y Date ... . ........... ................. By ................ Date ....... 'By ----------------
.............................
. ..... BY ................ Date ......
APPROVED - ----- ... By
.... . ....................................... .......................................... ......
.............
nar. .......... ................................................................................................................................................................ ..........
...........
...................... ......... ........ ............... ................. ................................................................ ........................................... ............
�1: B On. -H,111�rP it -le pies; Be Signed, By Owner of Firin, Performing Co'nstruc ion� PRIOR.*To Request For Inspection,
4! .............. ... ...................... ......................... .... hereby- certify thatthe -side sewer installation constructed under thispermit,
w.ner: of _ntra g Firm PerfG Ing Construction)
w,-4ristall An. accor, ance all go -ning ordinances of the,City. of.'Edmonds.
Dated: this .... .. I ................. day of ........ 4.
. ............................... ............... 19
'0
BEFORE, -Water' Ej, Gas ...Telephone' 'Pow Sewer E],
you; dig fory er Other
APPLICATION
for
Ahe City of Edmonds EASEMENT NO - ----------------------------------------------
S.IDE SEWER PERMI-T
NEW CONSTRUCTION nl--' REPAIRST� LID NO . ................... IASMT. NO - ------------------
OWNER ---------------------------- I --------- CONTRACTOR--- -------- ---------------- PERMIT NO..
ADDRESS ......... .... . "07 LEGAL DESCRIPTION: LOT NO . ....... ..................... BLOCK NO . ..................
........................................................................................................................................................
oe-
ITION .... 0
NAME OF ADD . . ............. ........................
. �-.Jge
Date September 17, 1975
Memo to: Director of Maintenance & Operation RECEIVEu
Public Works
From: City Engineer SEP 18 1975
Subject: Sewer Connection Charges
Legal Description:
Lot 17, Plat of R.C. Munger's Addition #3
Commonly known as: 21907 - 95th Ave. W. Owner: Angela Ingham
Z.F.F. Calculation:
o Z.F.F. x 0
0 Lateral x 0
Unit x 25
Per Agreement with developer
of Plat of Bellin Gardens
cc:
$ 0 Connection Fee
$ 0 Lateral Charge
$ 25.00 Trunk Charge
$ 10.00 Permit
$ 35.00 TOTAL
1 A
Form 6
--W
STREH FILE
Date September 17,, 1975
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description:
Lot 17, Plat of R.C. Munger's Addition #3
Commonly known as: 21907 — 95th Ave. 11. Owner: Angela Ingham
Z.F.F. Calculation:
0 Z.F.F. x 0
0 Lateral x
1 Unit x $ 25
Per Agreement with developer
of Plat of Bellin Gardens
cc:
$ 0 Connection Fee
$ 0 Lateral Charge
$ 25*()o Trunk Charge
$ 10-00 Permit
$ 35.00 TOTAL
Form 6
Or STREET FILE
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